Health care facility design, construction and renovation

1. Health care facility design, construction and renovation

2. Learning objectives • Describe the role of infection prevention and control in construction/renovation projects. • Define engineering, environmental and work practice controls. • Explain the importance of the environment in infection prevention and control. • Identify potential building-related infection risks.

3. Time involved • 50 minutes

4. Background Recommendations for design, construction and renovation of health care facilities must be based on: • experience • assessing infection risks • considering local resources Published evidence is scarce

5. Infection risks • Distance between beds less than 1 meter • Shortage of washing/changing facilities for staff • Overcrowding • Fungal spores in building materials and air • Contaminated water

6. Factors: spread of infection -1 • Numbers of patients and staff • Numbers and types of procedures and examinations • Available space • Numbers and types of rooms • Number of beds in a room

7. Factors: spread of infection -2 • Floors and surfaces • Water, electricity, and sanitation • Ventilation and air quality • Handling of used and unused medical equipment • Handling of food, laundry, and waste

8. Important design issues • Heating, ventilation, air-conditioning • Sinks, alcohol hand rub, soap, paper towels • Sharps and waste disposal • Walls, floors, furniture • Utility rooms for cleaning soiled items • Storage for patient care items and PPE • Bathrooms for patients, staff

9. Basic construction of a sterilisation unit

10. Numbers and types of rooms • Maximum 40 beds on a ward • Aim for more rooms with fewer patients • Single rooms for infectious patients • Provide space for visitors/helpers • Provide space for staff

11. Hand hygiene • Alcohol based hand rub • Liquid soap and paper towels • Reusable dispensers must be maintained and cleaned before refilling • Wash basins

12. Only single use bottles for disinfectants and fluid soap should be used Use mechanical water outlets instead of contact-less types– these are often colonised by water bacteria because of construction issues

13. Dispenser Placement

14. Floors and surfaces Surfaces should be smooth: • No unlacquered wood • No carpets • No cracks Prevents collection of moisture, secretions or chemicals

15. Surfaces must be able to withstand cleaning agents and disinfectants • Usually disinfectants are more corrosive than cleaning agents

16. Water, electricity and sanitation • Controlled and safe drinking water • Enough toilets for both sexes • Clean toilets daily • Electricity 24 h/day

17. Don´t store prepared food in storage rooms

18. Ventilation and air quality • Proper ventilation is necessary to prevent airborne infection • Natural ventilation if climate appropriate • Mechanical ventilation must be well maintained • Filters must be serviced

19. Barriers During Projects • Barriers should be selected to seal off the area during dust-producing activities • Examples of barriers include: • Closed doors with duct tape applied over the frames • Drywall room partitions with sealed seams • Plastic barriers • Dismantle barriers/temporary partitionsafter cleaning the work area in a manner to avoid dispersing dust • Protect patient care equipment and supplies from dust exposure

20. Deconstruction sheltered by plastic planes – less dust

21. Good shielding and renovation in reduced pressure

22. Renovation behind shielding

23. Insufficient shielding

24. Producing low pressure for renovation

25. Medical equipment • Separate clean and dirty procedures in designated areas • Use good cleaning and disinfection procedures for soiled items • e.g., bedpans • Prepare infusions and injections in a separate clean room/area • Store clean medical devices in a defined place • In closed lockers or cabinets

26. Infusions and syringes should not be prepared besides sinks – risk of transmission of aerosols from water • At least have a splash guard between sink and clean area

27. Incorrect storage of sterile products (these are heart catheters)

28. Food, laundry and waste • Prepare food for patients in a clean kitchen by trained staff • Hot food must be eaten while hot or chilled before storage • Bed linen and working clothes should be washed in a hospital laundry • Store dry and clean • Waste management guidelines available

29. Washer disinfector for beds

30. Clean and dirty work in different rooms/areas

31. Resource considerations • How many day-care and out-patients will you serve? • How many in- patients, how sick are they and how long will they stay in hospital? • Patients will require more privacy for procedures • How much staff do you have per patient? • How many unqualified helpers?

32. Infection prevention and control team - I • IP&C staff a link between medical personnel, architects and engineers • Prioritise areas with infection-prone patients: • Operating and delivery rooms • Intensive care units • Emergency rooms

33. Infection prevention and control team -2 • Take part in the initial design of the building • Consider the flow of patients, staff and equipment • Get involved with the facility management

34. SIG construction recommendations - 2012 • Design of a general ward   • Protection of immunocompromised patients during building work   • Emergency Unit   • Design of Intensive Care Units   • Design of a surgery block   • Ventilation to prevent airborne transmission Go to: www.theific.org

35. References • CDC Guidelines for environmental infection control in health-care facilities. MMWR 2003, June 6, 1-42. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf • Atkinson J, et al. Natural Ventilation for Infection Control in Health-Care Settings. World Health Organization 2009. http://www.who.int/water_sanitation_health/publications/natural_ventilation/en/ • WHO policy on TB infection control in health-care facilities, congregate settings and households. World Health Organization, 2009. http://whqlibdoc.who.int/publications/2009/9789241598323_eng.pdf

36. References • Guidelines for drinking-water quality. 3rd edition. World Health Organization, 2008. http://www.who.int/water_sanitation_health/dwq/fulltext.pdf • Healthcare waste and its safe management, WHO, 2008. http://www.healthcarewaste.org/en/115_overview.html • Infection Control Principles for the Management of Construction, Renovation, Repairs and Maintenance within Health Care Facilities. LoddonMallee Region Infection Control Resource Centre 2005. http://www.ihea.org.au/files/InfectionControlManual.pdf

37. Quiz • A key role of infection prevention and control in construction/renovation projects involves working with facility management staff during the initial design phase. T/F? • Potentialbuilding-related infection risks are • Proximity of patients to each other • Ease of carrying out best practices by staff • Air/water quality • All of the above • The following building factors influence spread of infections: • Numbers of patients and staff • Available space • Number of beds in a room • All of the above

38. International Federation of Infection Control • IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe . • The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. • For more information go to http://theific.org/